Coombe Women and Infants University Hospital, Dolphins Barn, Dublin 8, Ireland.
Hum Reprod. 2010 Feb;25(2):535-43. doi: 10.1093/humrep/dep398. Epub 2009 Nov 12.
Neural tube defects (NTDs) are severe abnormalities of the central nervous system that occur as a result of abnormal development in the third and fourth weeks of gestation. Studies have shown that periconceptional folic acid (FA) can reduce both the incidence and recurrence of NTDs.
A cohort study was carried out using the electronic hospital booking records of women delivering in a large Dublin maternity hospital between 2000 and 2007. Logistic regression analyses were performed to measure the associations between maternal factors and optimal FA use.
Of the 61,252 women in the cohort, 85% reported taking FA at some point during the periconceptional period; however, only 28% took FA as recommended. Factors associated with taking the recommended amount of FA included nulliparity [adjusted OR: 1.35 (95% CI: 1.28-1.43)], early booking (<12 weeks) [OR: 1.24 (95% CI: 1.17-1.31)], increasing maternal age (e.g. 30-34 years) [OR: 1.39 (95% CI: 1.30-1.48)], private health care [OR: 4.32 (95% CI: 4.1-4.6)] and fertility treatment [OR: 2.88 (95% CI: 2.44-3.40)]. Factors associated with taking less than recommended or no FA included unplanned pregnancy [OR: 0.08 (0.07-0.08)], lower socio-economic status (e.g. unemployed) [OR: 0.63 (95% CI: 0.55-0.71)], non-Irish nationality [OR: 0.82 (0.74-0.90)] and smokers [OR: 0.51 (95% CI: 0.47-0.55)].
Social, demographic and economic factors have an important influence on the FA uptake. Vulnerable groups who report limited uptake of FA need to be specifically targeted in future Public Health campaigns and further consideration needs to be given to the debate on food fortification in countries where this is currently not available.
神经管缺陷（NTDs）是中枢神经系统的严重畸形，是妊娠第三至第四周发育异常的结果。研究表明，围孕期叶酸（FA）的摄入既可以降低 NTDs 的发生率，也可以降低其复发率。
本研究采用队列研究方法，对 2000 年至 2007 年间在都柏林一家大型妇产医院分娩的妇女的电子医院预约记录进行分析。采用逻辑回归分析来衡量母体因素与最佳 FA 利用之间的关联。
在该队列的 61252 名女性中，85%的人报告在围孕期的某个时间点服用过 FA，但只有 28%的人按照建议服用 FA。与服用推荐剂量 FA 相关的因素包括未婚（调整后的 OR：1.35（95%CI：1.28-1.43））、早预约（<12 周）（OR：1.24（95%CI：1.17-1.31））、母亲年龄增加（例如 30-34 岁）（OR：1.39（95%CI：1.30-1.48））、私人医疗保健（OR：4.32（95%CI：4.1-4.6））和生育治疗（OR：2.88（95%CI：2.44-3.40））。与服用量低于推荐量或未服用 FA 相关的因素包括非计划妊娠（OR：0.08（0.07-0.08））、社会经济地位较低（例如失业）（OR：0.63（95%CI：0.55-0.71））、非爱尔兰国籍（OR：0.82（95%CI：0.74-0.90））和吸烟者（OR：0.51（95%CI：0.47-0.55））。
社会、人口统计学和经济因素对 FA 的摄取有重要影响。在未来的公共卫生宣传活动中，需要特别针对报告 FA 摄取量有限的弱势群体，并需要进一步考虑在目前尚未实施食品强化的国家开展食品强化的辩论。
